What Is the Best Pain Medication for Chronic Pain?

Identifying the best medication for chronic pain depends on underlying causes and how severe your symptoms are.

Pain is a complex combination of psychological, social, and biological factors. This means it involves not just a physical response to injury but also the individual experiences and beliefs that shape how you perceive pain.

Pain can happen every day. Sometimes it’s temporary, like when you stub your toe. However, for many people, pain becomes a chronic challenge.

Chronic pain, which is generally considered to be pain that lasts longer than several months , doesn’t last for just a set amount of time. Chronic pain is usually pain that persists past what’s considered a typical healing time.

Many medications can treat chronic pain, but the best options may change based on your circumstances. For instance, the cause of your chronic pain, whether due to injury or a medical condition, should be considered when choosing a treatment plan.

When you’re living with chronic pain, over-the-counter (OTC) medications are a common go-to. They’re accessible, fairly affordable, and available without a prescription because they have a good safety margin when taken as directed.

The older you get, the more you will be forced to spend on healthcare. A couple retiring at age 65 in 2018 will spend $280,000, on average, on medical costs throughout their retirement, not counting the expense of over-the-counter medications or the cost of living in a nursing home, CBS News

Pain medications are known as analgesics. OTC options for chronic pain include:

  • acetaminophen (Tylenol)
  • nonsteroidal anti-inflammatory drugs (NSAIDs)
  • topical products

Acetaminophen

Also known as paracetamol (brand name Tylenol) around the world, acetaminophen’s exact method of pain reduction isn’t well understood.

It’s sometimes classified as a COX inhibitor because part of its known function is blocking, or inhibiting, cyclooxygenase (COX). This is an enzyme that the body uses in prostaglandin production, which generates pain perception.

Acetaminophen is one of the most widely used OTC pain medications available. It’s in hundreds of products, from cold medications to sleeping aids.

Though it’s marketed for pain, acetaminophen may be less effective compared with other OTC products. This is because it doesn’t have significant anti-inflammatory properties.

Until recently, it was widely recommended for use throughout pregnancy, though warnings now suggest it should be used with caution.

Common side effects of acetaminophen use include:

  • blistering, peeling, or red skin
  • itching
  • hives
  • rash
  • facial swelling
  • swelling in the extremities
  • difficulty swallowing or breathing
  • hoarseness

Acetaminophen is the preferred medication for chronic pain if you live with kidney disease. This is because NSAIDs can increase the risk of acute kidney failure in people with reduced kidney function. However, it is not viable for people with liver disease.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are true COX inhibitors. They work by inhibiting COX-1 or COX-2 enzymes (or both). In this way, they block pain perception, but they also help decrease inflammation.

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Common OTC NSAIDs include:

NSAIDs are considered first-line options for nociceptive pain — pain that’s caused by damage to body tissue. They’re used in chronic musculoskeletal conditions like osteoarthritis or chronic back pain.

  • nausea
  • vomiting
  • diarrhea or constipation
  • swelling of the feet or ankles (edema)
  • gastrointestinal bleeding or ulcers
  • blood pressure increase
  • dizziness

Topical products

Topical OTC products are commonly used as supplements to other forms of long-term pain management, helping when the pain feels extra intense.

They can come as sprays, creams, ointments, or adhesive patches.

A 2020 research review found OTC patches containing lidocaine and capsaicin creams both helped improve general chronic lower back pain to the point where they could be considered first-line treatment options.

Common side effects of topical analgesics include:

  • skin reddening
  • rash
  • burning sensation at the application site

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